What does "out-of-network" coverage mean in the context of a Medicare Advantage plan?

In the context of a Medicare Advantage plan, "out-of-network" coverage refers to the scenario where beneficiaries receive services from healthcare providers who do not have a contract with the Medicare Advantage plan. When this happens, it typically results in higher out-of-pocket costs for the patient. Medicare Advantage plans usually have a network of preferred providers to manage costs, and using out-of-network providers means that individuals may face deductibles and coinsurance rates that are higher than what they would pay if they utilized in-network services.

While there might be some coverage for out-of-network services, the cost implications are significant, making it crucial for beneficiaries to understand how their chosen plan operates regarding network providers. This emphasis on potential additional costs associated with out-of-network care highlights the importance of knowing provider participation in the network.